Florida takes a step forward in mental health care, but two steps back in treating sick children

The struggle to adequately provide mental health continues, and Florida is the next state to attempt to figure out the problem. Wolters Kluwer has recently reported on the industry’s difficulty in providing mental health services for various reasons, such as a shortage of psychiatrists, an aging practitioner base, and state level issues with coordinating care and meeting resident needs in North Dakota and Massachusetts. According to Florida Governor Rick Scott (R), the state’s mental health programs are too fragmented.  Despite these gains, some medical directors are launching accusations about the alleged “dismantling” of the Children’s Medical Services program, saying that sick and disabled children are being deprived of care.

Time for a plan

The governor expanded a previous Executive Order to various state agencies via addendum. The order originally charged the Department of Corrections (DOC), the Department of Children and Families (DCF) and the Department of Juvenile Justice (DJJ) to develop and implement better management practices related to mental health services. This order included a pilot program in Broward County that would conduct an inventory of all programs across all agencies that provide mental health needs. Scott hopes that streamlining access to these services will provide more timely access for those who need it, especially considering that many with untreated mental illnesses become incarcerated. The agencies do not currently share information, citing privacy laws.

The addendum expands the pilot programs to include Alachua and Pinellas counties. It also includes the Department of Health and the Agency for Health Care Administration in the list of agencies involved, as the addendum states that “both play a critical role with respect to mental health care services in Florida.” Ultimately, Scott hopes that the review will result in developing a coordinated system of behavioral care services. This system should include streamlined budgeting and tracking of health care spending. The DCF is tasked with auditing state mental health treatment facilities. The audit will examine patient care and safety, security, technology, productivity, staffing, organization, and training. The DCF will then advise Scott regarding the best methods for coordinating care and optimizing resources. In the end, this integrated system should help both youth and adults with mental illnesses as well as those involved in criminal and juvenile justice systems, the child welfare system, and those in treatment facilities.

Some suggest a central receiving facility as an option for improving the system. Those experiencing a mental health crisis would be directed to this facility, and then treatment would be coordinated between the agencies. Denise Marzullo, president and CEO of Mental Health America of Northeast Florida is “cautiously optimistic” about the plan. The governor’s office recently vetoed the funding for other mental health initiatives, so some are hoping that the audits and restructuring indicate that mental health care is becoming a priority for the governor.

Child health care

According to the Miami Herald, medical directors and assistant directors throughout Florida have addressed state health administrators about the changes to the Children’s Medical Services program. The directors say that extremely sick children are being forced to wait for treatment while a new program is being implemented. The state is accused of gutting the program without offering an explanation or input from providers.  The program is now so diminished that it no longer meets accreditation criteria. This is a serious concern, as accreditation is necessary to operate as a Medicaid managed care agency. The Health Department denied the accusations, saying that a moratorium on new admissions has never been imposed. Medicaid and the Children’s Medical Services program are being run by managed care entities, and the Health Department plans to enroll any children removed from the medical services program in Medicaid plan. Yet this raises more concerns, as the state’s managed care program has been a controversial topic and last December a judge ruled that the system for needy and disabled children violated federal laws. Although the state argued that more money has been infused into the system and that the judge’s decision is now moot, the children’s advocates strongly deny this point. The directors suggest that the administrators have purposely excluded the doctors running the program.